Message standards now exist for transferring patient observations from their source systems. such as the laboratory, transcription, and radiology systems, to computer based medical record systems. Hospitals and group practices face large economic and practical barriers because toolkits for implementing these standards and universal codes for identifying distinct test results, clinical measurements, and sections of dictated reports transmitted via these standards are lacking. Just interfacing a laboratory system to a medical record system can take 1-2 years because of the need to map from the laboratory's locally defined test IDs to the medical record's lab test terminology. We propose to eliminate these barriers by 1) developing a portable set of C++ programs/subroutines for sending and receiving patient observations (numbers, text and images) between independent systems using standard medical informatics (ASTM/HL7 and DICOM) and Internet protocols; and 2) developing naming conventions and assigning a fully specified name and code for each unique laboratory test result, most clinical measurements, and components of narrative clinical reports, taking into account, method, body site/specimen sources, and physiologic challenges. We will test the toolkit and naming conventions on the Regenstrief Medical Record System, obtain input from the relevant standard groups, and make these tools freely available via Internet file servers and/or the National Library of Medicine.